A major “thank you” to Jen Knapp for coming in and talking with us today about something deeply personal. We hope that this talk causes all of us to reflect on the way we approach these situations and opens a dialogue to caring for patients with special considerations.

COMMON MISCONCEPTIONS ABOUT AUTISM

Autism is often lumped into the “mental illness” category; Autistic patients have a higher likelihood of developing additional mental illnesses (i.e. anxiety, ADD/ADHD, etc), but Autism is not a mental illness in and of itself.

Despite the stereotype, Autistic patients are not naturally violent; the agitation is typically a result of unidentified stressors by the provider.

Not all Autistic patients have the same triggers.

Autism does not signify lack of intelligence; however, there is significant difficulty understanding nuanced language.

OPTIMIZING YOUR ASSESSMENT

If there is a caregiver present, talk to them. They will most likely understand how the patient copes with stress, how to deescalate frustrating situations, and also have a general understanding of other co-morbidities.

Explain what you are doing before you do it.

Don’t speak it riddles. Be clear. Be concise. Be brief.

Limit the amount of people in the room. Numbers are not your friend in this instance; too many cooks in the kitchen tends to lead towards escalated tempers and misunderstanding.

If you have the ability to limit noises (i.e. radios, sirens, etc) or flashing scene lights, do it.

RECOGNIZING AND APPROACHING CONFLICT

Repetitive motions are typically a sign of increased agitation; the motions are an attempt to sooth the ongoing anxiety; once you recognize this stop what you are doing and reapproach the situation in a slower manner, allowing the patient time and distance.

If the patient is severely agitated, genuinely ask yourself if this is a behavioral outlet or a danger to the patient. If the behavior makes you uncomfortable, but it isn’t endangering the patient, the best thing to do is to let the behavior run its course.

Time and respect will do the most in diffusing these situations once they’ve escalated. Attempting to assert dominance will only worsen things.

The majority of this is common sense, but take a second and think about the last time you dealt with a combative of agitated patient… How did you handle it?

FINAL THOUGHTS

Caring for an Autistic patient can be a challenge; recognize that their caregivers might need your support just as much, if not more than the patient.

Slow down! Everyone involved in emergency medicine is time focused… This an opportunity to pump the brakes and care for the patient as a whole, and not just focus on a specific malady.